Application of endoscopically assisted right parasternal second intercostal transverse incision approach aortic valve replacement in patients with aortic valve disease
Aim:To observe the application of endoscopically assisted right parasternal second intercostal transverse in-cision approach aortic valve replacement in patients with aortic valve disease.Methods:A total of 86 patients with simple aortic valve disease treated in Fuwai Central China Cardiovascular Hospital from January 2020 to May 2023 were selected.The patients with median incision approach were included in control group(n=42),and the patients with endoscopically as-sisted right parasternal second intercostal transverse incision approach were included in the observation group(n=44).Perioperative indexes,NRS score,complications,hemodynamics indexes[left ventricular ejection fraction(LVEF),stroke output(SV),cardiac output(CO)],ventricular remodeling indexes[left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),right ventricular diameter(RV)],oxidative stress indexes[superoxide dismutase(SOD),malondialde-hyde(MDA),myeloperoxidase(MPO)]changes of the 2 groups were observed.Results:The durations of cardiopulmonary bypass and ascending aorta occlusion in the observation group were longer than those in control group,and the length of inci-sion,CSICU admission and postoperative hospitalization were shorter than those in control group(P<0.05).The NRS score increased first and then decreased on the 1st,3rd,and 7th day after operation,and the NRS score of the observation group was lower than that of control group(P<0.05).After operation,LVEF,SV and CO increased while LVEDD,LAD and RV decreased in the 2 groups(P<0.05),but there was no significant difference between the 2 groups(P>0.05).On the3rd and 7th day after operation,MPO and MDA levels in the 2 groups were both increased and SOD level decreased,and the ob-servation group had better improvements(P<0.05).The incidence of atrial fibrillation in the observation group was 9.1%,lower than that in control group(31.0%,P<0.05).Conclusion:Endoscopically assisted right parasternal second intercostal transverse incision approach aortic valve replacement in the treatment of aortic valve disease can effectively im-prove cardiac hemodynamics,partially reverse ventricular remodeling,alleviate postoperative pain and oxidative stress,re-duce the risk of postoperative atrial fibrillation,and accelerate the rehabilitation process.
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